Healthcare Provider Details

I. General information

NPI: 1114786076
Provider Name (Legal Business Name): MARY KAITLYN HEALEY OT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2024
Last Update Date: 03/14/2024
Certification Date: 03/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29460 FORD RD
GARDEN CITY MI
48135-2318
US

IV. Provider business mailing address

29460 FORD RD
GARDEN CITY MI
48135-2318
US

V. Phone/Fax

Practice location:
  • Phone: 734-522-0065
  • Fax: 734-522-0068
Mailing address:
  • Phone: 734-522-0065
  • Fax: 734-522-0068

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number5201013400
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: